Inguinal Hernia

Topic Overview

Is this topic for you?

If you do not have an inguinal hernia, see
information on
common types of hernias. These include incisional, epigastric, and umbilical hernias in children and adults.

What is an inguinal hernia?

An inguinal hernia
(say "IN-gwuh-nul HER-nee-uh") occurs when tissue pushes through a weak spot in
your groin muscle. This causes a bulge in the groin or scrotum. The bulge may
hurt or burn.

What causes an inguinal hernia?

Most inguinal
hernias happen because an opening in the muscle wall does not close as it
should before birth. That leaves a weak area in the belly muscle. Pressure on
that area can cause tissue to push through and bulge out. A hernia can occur
soon after birth or much later in life.

You are more likely to get
a hernia if you are overweight or you do a lot of lifting, coughing, or
straining. Hernias are more common in men. A woman may get a hernia while she
is pregnant because of the pressure on her belly wall.

What are the symptoms?

The main symptom of an
inguinal hernia is a bulge in the groin or scrotum. It often feels like a round
lump. The bulge may form over a period of weeks or months. Or it may appear all
of a sudden after you have been lifting heavy weights, coughing, bending,
straining, or laughing. The hernia may be painful, but some hernias cause a
bulge without pain.

A hernia also may cause swelling and a feeling
of heaviness, tugging, or burning in the area of the hernia. These symptoms may
get better when you lie down.

Sudden pain, nausea, and vomiting
are signs that a part of your intestine may have become trapped in the hernia.
Call your doctor if you have a hernia and have these symptoms.

How is an inguinal hernia diagnosed?

A doctor can
usually know if you have a hernia based on your symptoms and a physical exam.
The bulge is usually easy to feel.

How is it treated?

If you have a hernia, it will
not heal on its own. Surgery is the only way to treat a hernia.

If
your hernia does not bother you, you most likely can wait to have surgery. Your
hernia may get worse, but it may not. In some cases, hernias that are small and
painless may never need to be repaired.

Most people with hernias
have surgery to repair them, even if they do not have symptoms. This is because
many doctors believe surgery is less dangerous than
strangulation, a serious problem that occurs when part
of your intestine gets trapped inside the hernia.

But you may not
need surgery right away. If the hernia is small and painless and you can push
it back into your belly, you may be able to wait.

Babies and young
children are more likely to have tissue get trapped in a hernia. If your child
has a hernia, he or she will need surgery to repair it.

A hernia
may come back after surgery. To reduce the chance that this will happen, stay
at a healthy weight. Do not smoke, avoid heavy lifting, and try not to push
hard when you have a bowel movement or pass urine.

Cause

Inguinal hernias, which occur when tissue bulges through the abdominal (belly) muscles
and into the groin, are caused by:

An opening in the passage from the abdomen to
the genitals (called the
inguinal canal) that should close before birth but
does not.

Abdominal muscles that are weakened by aging and the
daily wear and tear of life.

Conditions that increase pressure within the abdominal
cavity, such as frequent coughing or being overweight, may contribute to the
development of hernias.

A
femoral hernia, sometimes mistaken for an inguinal
hernia, occurs when tissue bulges from the lower abdomen into the upper thigh,
just below the groin crease. The cause of a femoral hernia is often difficult
to determine.

If you do not have an inguinal hernia, you may have one of the other
common types of hernia. These include incisional, epigastric, and umbilical hernias in children and adults.

Symptoms

A bulge in the
groin or
scrotum. The bulge may appear gradually over a period
of several weeks or months. Or it may form suddenly after you have been lifting
heavy weights, coughing, bending, straining, or laughing. Many hernias flatten
when you lie down.

Groin discomfort or pain. The discomfort may be
worse when you bend or lift. Although you may have pain or discomfort in the
scrotum, many hernias do not cause any pain.

You may have sudden pain, nausea, and vomiting if part of
the intestine becomes trapped (strangulated) in the hernia.

Other symptoms of a hernia include:

Heaviness, swelling, and a tugging or burning
sensation in the area of the hernia, scrotum, or inner thigh. Males may have a
swollen scrotum, and females may have a bulge in the large fold of skin (labia)
surrounding the vagina.

Discomfort and aching that are relieved
only when you lie down. This is often the case as the hernia grows
larger.

Hernia symptoms in children

In infants, a hernia
may bulge when the child cries or moves around.

Strangulated
hernias, in which part of the intestine becomes trapped in the hernia, are more
common in infants and children than in adults. They can cause nausea and
vomiting. An infant with a strangulated hernia may cry and refuse to eat.
A
strangulated hernia is a medical emergency that requires
immediate surgery.

What Happens

Inguinal hernias typically flatten or disappear when
they are pushed gently back into place or when you lie down. Over time, hernias
tend to increase in size as the abdominal muscle wall becomes weaker and more
tissue bulges through.

If you can't push your hernia back into
your belly, it is
incarcerated. A hernia gets incarcerated when tissue
moves into the sac of the hernia and fills it up. This is not necessarily an
emergency.

But if a loop of the intestine is trapped very tightly
in the hernia, the blood supply to that part of the intestine can be cut off
(strangulated), causing tissue to die. In a man, if
tissue is trapped, the testicle and its blood vessels can also be damaged. A
strangulated hernia is a medical emergency that requires
immediate surgery.

In adults, a hernia that can be pushed back
into the abdomen can be surgically repaired at a convenient time. This is
because strangulation is rare in adults. A hernia that cannot be pushed back
can be repaired when surgery is convenient unless you have increased pain,
redness of the overlying skin, fever, nausea and vomiting, or abdominal
bloating. If any of these symptoms occur, the hernia may need to be fixed
sooner.

Inguinal hernias can come back after surgical repair. But
in women it is rare for inguinal hernias to recur.

Hernias in children

Infants or children with an
inguinal hernia need to have surgery as soon as possible because of the
increased risk that a part of the intestine will become trapped and blood
supply will be cut off, leading to tissue death.

Incarceration,
when intestinal or abdominal tissue fills up the sac of a hernia, occurs in
about 2 or 3 out of 10 infants younger than 6 months who have hernias. Most
incarcerated hernias occur before the infant is 1 year old.1 Female infants face a higher risk of incarceration.

What Increases Your Risk

Many things can increase
your risk for having an
inguinal hernia.

Risk factors you can change

Being overweight or having a recent, large
weight loss (such as in crash dieting)

Having weak abdominal
muscles from poor diet, lack of exercise, or both

Straining during
urination or bowel movements

Chronic coughing, such as from
smoking

Risk factors you cannot change

Being male

Having muscle weakness
from birth, along with a hernia sac

Having muscle weakness from
aging

Having one or more inguinal hernias

Risk factors for inguinal hernia in children

In
children, risk factors for inguinal hernia include:

Being born early and having low birth weight
[less than 1500 g (3.3 lb)].

Having one or both testicles that do not descend
into the scrotum (undescended testicle).

Having a family history of
inguinal hernia.

Having certain other birth defects or conditions,
such as characteristics of each sex in a baby's genitals (ambiguous genitalia),
abnormal position of the opening of the
urethra on top of (epispadias) or underneath
(hypospadias) the penis, or
hydrocele, in which fluid builds up around one or both
testicles.

When To Call a Doctor

Call a doctor immediately if:

Your child has an
inguinal hernia that cannot be pushed back into the
abdomen with gentle pressure.

You or your child has an inguinal
hernia and symptoms of
strangulation, such as nausea, vomiting, fever,
tenderness, and severe cramping pain in the
groin area. These symptoms mean that the intestine
has lost blood supply.

Call a doctor if:

Your infant has a definite lump in the groin
area.

You or your child has a tender bulge in the groin or
scrotum, even if the bulge disappears when lying
down.

You or your child has increasing groin discomfort or pain.
The discomfort may be increased by bending or lifting and may extend into the
scrotum.

Talk with your doctor before wearing a corset or
truss for a hernia. These devices are not recommended
for treating hernias and sometimes can do more harm than good.

Watchful waiting

Watchful waiting is a period of time during
which you and your doctor observe your symptoms or condition but you do not
receive medical treatment. If you are not sure whether you have groin muscle
strain or a hernia, watchful waiting with home treatment for 1 to 2 weeks is
appropriate. If you have pain that is increasing or severe, an obvious lump, or
evidence of bowel blockage or urinary symptoms, call your doctor for an
evaluation.

Watchful waiting is not
appropriate for infants and children who have inguinal hernias.

You and your doctor can decide whether you should have surgery to fix
your hernia or if you can wait. If your hernia does not bother you, you can
probably wait to have surgery.

Exams and Tests

The diagnosis of
inguinal hernia is usually based on your medical
history and a
physical exam. Tests such as ultrasound and CT scans
are not usually needed to diagnose an inguinal hernia. In most cases, a doctor
can identify an inguinal hernia during a physical exam.

A urine test (urinalysis)
may be done to rule out a urinary tract infection. A urinary tract infection or
kidney stone may cause pain in the groin that can be mistaken for hernia pain.
Further tests may be done to rule out other conditions that could be
contributing to the hernia, such as colon or
prostate cancer or lung diseases that cause chronic
coughing.

If surgery is planned, other tests may be needed to
evaluate the status of any current health problems, such as lung, heart, or
bleeding problems.

Treatment Overview

Surgery is the only treatment and cure for
inguinal hernia. Hernia repair is one of the most
common surgeries done in the United States. About 750,000 people have hernia
repairs each year.2

Many doctors recommend surgery to repair a
hernia because it prevents
strangulation, which occurs when a loop of intestine
is trapped tightly in a hernia and the blood supply is cut off, which kills the
tissue. Strangulation requires immediate surgery, although the condition is
rare in adults. Infants and
children always need surgery to repair a hernia because of the increased risk of
incarceration and strangulation.

If your hernia does not bother you, you may
not need to have surgery. Waiting to have surgery does not increase the chance
that part of your intestine or abdominal tissue will get stuck in your hernia.
Waiting will also not increase your risk for problems, if you decide to have
surgery later. In some cases, hernias that are small and painless may never
need to be repaired.

Talk with your doctor before wearing a corset or
truss for a hernia. These devices are not recommended
for treating hernias and sometimes can do more harm than good.

Hernias in children

In a child, a hernia that is
incarcerated may be pushed back into the abdomen by a doctor. But surgery is
still needed because of the increased risk of strangulation.

If the doctor cannot push the hernia back at
the time of the exam, the child may be sedated and laid down with his or her
head lower than the body, with an ice pack over the hernia.

If the
hernia does not reduce on its own, the doctor may try to push it back into the
abdomen.

If the hernia is reduced, surgery can be delayed for a
short time.

If the hernia cannot be reduced, immediate surgery is
needed.

What to think about

A surgeon's experience
plays an important role in the risk of a hernia recurring. If you are
thinking about having hernia surgery, ask the surgeon how many of these surgeries he or
she has done and about his or her recurrence rates. Recurrence rates for adults tend
to be higher for surgeries that do not use mesh (a synthetic patch).

Some people with other medical conditions may choose not to have surgery
or may not be able to have hernia surgery.

People with major health problems, such as
uncontrolled diabetes, may need to bring these conditions under control before
having hernia surgery.

Conditions that cause coughing or straining
to pass stools or urine (such as lung diseases or
prostate problems) may need to be treated before
surgery so that the hernia is less likely to recur after repair.

Prevention

Most
inguinal hernias cannot be prevented, especially in
infants and children. Adults may be able to prevent a few hernias or prevent a
hernia from recurring by following some of these suggestions:

Avoid rapid weight loss (such as in crash dieting). Rapid
weight-loss programs may be lacking in protein and vitamins that are needed for
muscle strength, causing weakness in the muscles of the
abdomen.

Stop smoking. Chronic coughing from smoking increases the
risk for developing a hernia.

Use good body mechanics when you lift heavy
objects. Lift with your legs, not with your back. For more information, see the
topic
Back Problems: Proper Lifting.

Surgery

Surgery has generally been recommended for
all
inguinal hernias to avoid complications such as
strangulation, in which a loop of intestine becomes tightly trapped in a
hernia, cutting off the blood supply to that part of the intestine.

If a hernia in an adult can be pushed back (reduced), surgery can be done
at the person's convenience. If it cannot be pushed back, surgery must be done
sooner. But surgery
may not be needed if the hernia is small and you do not have symptoms. Consult
with your doctor to
decide if you need hernia repair surgery.

Surgery in children

In most cases, a child with an
inguinal hernia will need
surgery to correct it.

Infants 6 months
of age and younger who have inguinal hernias have a much higher risk of
strangulation than older children and adults. So surgery for inguinal hernias
in infants is not delayed like it can be for adults.

Synthetic patches are not needed to repair an inguinal hernia
in an infant.

Some infants with inguinal hernias may need to be
hospitalized for surgery rather than have surgery in an outpatient setting. These
include infants who have lung problems, seizure disorders, or heart diseases from
birth or those who were born prematurely.

One of the major decisions concerning infants and
children is whether to explore the opposite
groin area for a hernia during a hernia repair. A
hernia develops in the other side of the groin in about 30 out of 100 children who
have had hernia surgery.

Things to think about in deciding whether
the other side should be explored include the overall health of the child, the
risk of
incarceration of a hernia, and the experience level of
the surgeon (how many of these surgeries the doctor has done and his or
her recurrence rates).

Recurrent inguinal hernias are harder to
repair and pose more risks than initial hernia repairs. The risks linked with
recurrent hernia surgery are more scar tissue, numbness and pain after surgery,
and a greater chance of injury to a testicle or the
spermatic cord.

Conditions that might increase the risk of recurrence include abdominal muscles that are not
strong or healthy enough to "hold" the stitching (suture) material and bleeding
or infection that weaken the repair.

Fertility is usually not
affected by an inguinal hernia or hernia surgery. But in males there is a
chance that surgery or an incarcerated hernia can cause injury to the
vas deferens, the tube that carries sperm from the
testicles to the urethra. It is not yet known how often or to what degree this
affects a man's ability to father a child. In rare cases, surgery or an
incarcerated hernia may injure the blood vessels that supply one or both
testicles with blood, which may cause the affected testicle to shrink.

Other Places To Get Help

Organizations

HealthyChildren.org

141 Northwest Point Boulevard

Elk Grove Village, IL 60007

Phone:

(847) 434-4000

Web Address:

www.healthychildren.org

This American Academy of Pediatrics website has information for parents about childhood issues, from before the child is born to young adulthood. You'll find information on child growth and development, immunizations, safety, health issues, behavior, and much more.

National Digestive Diseases Information Clearinghouse

2 Information Way

Bethesda, MD 20892-3570

Phone:

1-800-891-5389

Fax:

(703) 738-4929

TDD:

1-866-569-1162
toll-free

Email:

nddic@info.niddk.nih.gov

Web Address:

www.digestive.niddk.nih.gov

This clearinghouse is a service of the U.S. National
Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the
U.S. National Institutes of Health. The clearinghouse answers questions;
develops, reviews, and sends out publications; and coordinates information
resources about digestive diseases. Publications produced by the clearinghouse
are reviewed carefully for scientific accuracy, content, and readability.

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use.
How this information was developed to help you make better health decisions.